The Risk Continuum of Atherosclerosis and its Implications for Defining CHD by Coronary Angiography

• Published in: Journal of the American College of Cardiology Vol. 68; no. 22; pp. 2467 - 2478
• Main Authors: Arbab-Zadeh, Armin, MD, PhD, MPH, Fuster, Valentin, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 06.12.2016; Elsevier Limited
• Subjects: Atherosclerosis - diagnosis; atherosclerotic plaque; Cardiology; Cardiovascular; Cardiovascular disease; Coronary Angiography - methods; coronary artery disease; Coronary Disease; Coronary Vessels - diagnostic imaging; Health risk assessment; Humans; Internal Medicine; ischemic heart disease; Medical imaging; Risk Factors; Statins; Veins & arteries; Vitamin E; coronary artery disease; computed tomography; CT; FFR; left anterior descending artery; ischemic heart disease; coronary heart disease; atherosclerotic plaque; CHD; fractional flow reserve; LAD
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.08.069

Abstract Patients undergoing coronary angiography for suspected coronary heart disease who are found to have coronary atherosclerotic disease with <50% diameter stenosis may carry a risk of adverse cardiac events similar to that in patients with single-vessel obstructive disease. Yet clinical practice guidelines offer no direction for managing symptomatic patients with nonobstructive coronary atherosclerosis because current diagnostic criteria for coronary heart disease are not met. Accordingly, secondary preventive measures are not endorsed, and their role is not defined in this setting. Available data suggest that we are missing the opportunity to provide effective preventive measures in millions of patients with nonobstructive coronary heart disease. The emergence of noninvasive coronary angiography in patients with suspected coronary heart disease provides the opportunity to transition from a categorical perspective on the presence or absence of coronary heart disease to accepting the risk continuum from atherosclerosis and its implications for diagnosis and management.